Individual
DR. JONATHAN MICHAEL DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1811 E BERT KOUNS INDUSTRIAL LOOP STE 210, SHREVEPORT, LA 71105-5740
(318) 212-3858
(318) 212-3958
Mailing address
1811 E BERT KOUNS INDUSTRIAL LOOP STE 210, SHREVEPORT, LA 71105-5740
(318) 212-3858
(318) 212-3958
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
200400661
NC
207RC0000X
Cardiovascular Disease Physician
Primary
201971
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1330612
—
LA
Enumeration date
12/06/2007
Last updated
07/06/2021
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